The promotion of transgender issues on social media should be subject to safeguarding measures, according to the lawyer for a woman who brought last week’s landmark case against England’s only NHS gender identity development service (GIDS).
Keira Bell, 23, who was born female, was referred to the Tavistock Centre in London, which runs GIDS, as a teenager. She was prescribed puberty blockers at the age of 16.
Bell, who now regrets transitioning, argued that the centre should have challenged her more on her decision to transition to a male.
After hearing her case, the high court ruled that children under 16 were unlikely to be able to give informed consent to receive puberty-blocking drugs.
In the wake of the ruling, which means referrals for the drugs and cross-sex hormones for under-16s will be permitted only when approved by a court, Paul Conrathe, Bell’s solicitor, said wider questions now had to be asked about the role of the internet.
“If you read Keira Bell’s story, she says at various points: ‘I had my doubts but I gained courage from the internet.’
“I think there is a need for safeguarding guidance on protecting children from information that will encourage them down an experimental medical pathway.”
The role of social media has been cited as a possible factor in the sharp rise in the number of young people approaching GIDS for help.
But many parents of transgender children discount it. One mother, who said she was now considering going abroad to obtain help, said her child did not “decide” on their transgender identity.
“It is natural,” she said. “It might be statistically uncommon, but then so too is ginger hair.”
She added: “This echoes a discussion which used to be found around homosexuality, with questions like, when did you decide to be gay? Most people now accept that being straight or gay is not a decision; rather, sexuality is something which arises naturally.”
The Bayswater Support Group, which describes itself as supporting “the parents of children with adolescent-onset gender dysphoria” who want to “explore all options before resorting to irreversible medical treatments and surgery”, welcomed the ruling.
A spokesperson said the UK’s current approach affirming a child’s need to transition was embedded at an institutional level.
One mother belonging to the group said: “Nothing can describe the fear you feel as a parent when you realise that medical transition is the only solution presented to your child for distress around their gender identity. Given that institutions – from schools to government, charities to the NHS – have supported this route, we have felt powerless to intervene.”
But the ruling, which has been attacked by Amnesty International and Liberty, has dismayed many parents of transgender children.
“I did not imagine for one moment that the outcome of this case would be the effective withdrawal of medical care from children in dire need of it, and the removing of medical decisions from the hands of specialist doctors and the placing of them instead into the hands of judges who are not medically qualified,” said Molly Muirhead, the mother of a transgender boy.
She added: “I thought the facts were so abundantly clear that, waiting lists aside, no one serious could object to the status quo.
“Trans children go through a period of lengthy assessment before a decision is taken by a specialist medic about whether they should be prescribed puberty blockers – a safe, reversible treatment which temporarily pauses puberty, gives a child thinking time, and saves them from having to watch their body transform in a way which causes them profound distress.”
But Conrathe hailed the ruling as a “historic judgment that protects children”. He said the court had found that puberty blockers were an experimental treatment with a very limited evidence base for their effectiveness, and it was unclear if they offered any benefit.
Conrathe, who said he believed that the ruling would open the door to claims for damages against GIDS from people who now regretted transitioning, said the court had agreed that blockers were part of a treatment pathway on to cross-sex hormones, which have irreversible life-long consequences.
GIDS has suspended referrals for hormone therapy for all under-16s as a result of the ruling.
About 3,000 children are currently being seen at GIDS, several hundred of whom are receiving hormone therapy. Almost 5,000 are on its waiting list.
It is thought that many will require urgent mental health support as they digest the consequences of the ruling, but it is unclear whether more resources can be allocated. Mental health services for young people are already under acute pressure as a result of the pandemic.
Concerns about the rising number of children being seen at GIDS were raised by David Bell, staff governor at the Tavistock.
In a report, submitted to the trust’s board in 2018 and whose findings were first reported in the Observer, Bell said the service was failing to fully consider psychological and social factors in the backgrounds of young people wanting to transition.
According to his crowdfunding website, Bell is now “seeking legal advice regarding disciplinary proceedings which the Tavistock and Portman Trust has instituted against him in connection with his speaking and writing on the subject of gender dysphoria.”
Sonia Appleby, the trust’s safeguarding children lead, has also lodged a claim against the trust, alleging that “clinicians were discouraged from reporting safeguarding concerns to me”.
A spokeswoman for GIDS said it could not comment on ongoing legal matters.